Association Of Insomnia Symptoms Research Articles

Association of insomnia symptoms with neurocognitive impairment in COVID-19 survivors

Association of insomnia symptoms with neurocognitive impairment in COVID-19 survivors

Insomnia trajectories predict chronic inflammation over 2 years at the transition to adulthood.

Insomnia in adolescents is an important public health concern, as its impacts on both their current and future physical and mental health has been discussed. However, few longitudinal studies have examined insomnia and chronic inflammation at the transition from adolescence to adulthood. This study aimed to examine the predictive effects of insomnia and insomnia trajectories on inflammation in college students by using a prospective design. Using data from the College Student Behaviour and Health Cohort Study, which was conducted between April 2019 and April 2021, with an interval of 6 months. We investigated the associations between insomnia trajectories from Year 1 to Year 3 and five inflammatory biomarkers (C-reactive protein [CRP], tumour necrosis factor [TNF]-α, interleukin [IL]-6, IL-1β, IL-10) at Year 3. The association of insomnia symptoms at baseline, Wave 1 or Wave 2 with inflammatory biomarkers at Wave 4 were also assessed. A total of 312 college students (males: 51.6%) aged 16-26 years (mean [SD] 18.82 [1.22] years) were analysed. We identified two insomnia trajectory classes: increasing insomnia (n = 63 [20.2%]) and decreasing insomnia (n = 249 [79.8%]). Generalised linear model analysis revealed that insomnia symptoms at Wave 1 were associated with significantly elevated CRP and TNF-α levels at Wave 4. Increasing insomnia trajectories predicted consistently higher levels of CRP, TNF-α and IL-10. However, after adjusting for potential confounders, these associations were significantly attenuated. Overall, the findings suggest that insomnia symptoms affect chronic inflammation at the transition to adulthood. Our study needs to be replicated in larger cohorts to further explore how inflammation interacts with insomnia to increase the susceptibility to adverse health conditions.

The trajectories and associations of insomnia symptoms with addictive behaviours in adolescents: A two-year longitudinal study.

Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age=13.17 years). The three-wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best-fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non-insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR=2.203 [95% CI: 1.258-3.858]) and substance use (OR=2.215 [95% CI: 1.324-3.705]) compared with the non-insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours.

The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder.

The current study aimed to examine the association of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder (ADHD). Thirty-six children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia symptoms, and 21 age-matched healthy controls were recruited in this study (age range: 6-12 years, 70% male). They were assessed by parent-report questionnaires on insomnia symptoms (Children's Sleep Habits Questionnaire) and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale [SWAN]), and completed a battery of cognitive tests including the Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span forward test and N-back task for working memory, Tower of London (TOL) test for planning skills and Bergs Card Sorting Test (BCST) for set-shifting ability. Children with ADHD and insomnia symptoms had the highest scores on SWAN total and inattention and hyperactivity subscales, followed by children with ADHD without insomnia and healthy controls (all P < .05). After controlling for potential confounders, children with ADHD and insomnia symptoms showed poorer performance on the CPT and Letter-digit test as compared with children with ADHD without insomnia and healthy controls (all P < .05). Insomnia symptoms are associated with more severe ADHD symptoms and cognitive impairments in children with ADHD, especially deficits in sustained attention and processing speed. Future longitudinal studies are needed to explore the long-term impacts of insomnia symptoms and the effects of sleep-focused intervention on cognitive functioning in children with ADHD. Li X, Shea KSC, Chiu WV, etal. The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder. J Clin Sleep Med. 2022;18(8):2029-2039.

Associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors in persons with HF: Health and retirement study.

Insomnia symptoms are very common in persons with heart failure (HF). However, many of the correlates and predictors of insomnia symptoms in this population remain unclear. The purpose of this study isto investigate the associations of sociodemographic, clinical, and lifestyle factors with insomnia symptoms in persons with HF. A theoretical framework was adapted from the neurocognitive model of chronic insomnia to guide the study. Data from the health and retirement study were used for the analysis. Parametric and nonparametric bivariate and multivariate analyses were conducted to investigate these associations. Age, depressive symptoms, comorbidity, dyspnea, pain, and smoking had significant bivariate associations with all insomnia symptoms. Race, Hispanic ethnicity, marital status, household income, poverty, and physical activity were associated with difficulty initiating sleep (DIS) and early morning awakening (EMA). Female sex, education, and alcohol consumption had a significant bivariate association with DIS. Sleep-disordered breathing and body mass index were significantly associated with EMA. Multivariate analysis suggested that depressive symptoms, comorbidity, dyspnea, and pain had independent associations with each insomnia symptom. Age explained DIS and difficulty maintaining sleep, and significant interaction effects between age and physical activity on DIS and EMA were revealed. Results suggest that insomnia symptoms are associated with several sociodemographic, clinical, and lifestyle factors. Age below 70 years, depressive symptoms, comorbidity, dyspnea, and pain might be considered as a phenotype to identify persons with HF who are at increased risk for insomnia symptoms.

Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older.

To evaluate the association of the different degrees of insomnia symptoms with subsequent incidence of type 2 diabetes mellitus (T2DM). The data were extracted from Health and Retirement Study 2006-2014 waves. The association of insomnia symptoms with T2DM incidence was evaluated by the competing risk model with cumulative incidence function (death was considered a competing event) and Cox proportional hazard model with the Kaplan-Meier method. Population attributable fraction (PAF) was calculated. All analyses related to our study were conducted between November 2020 and January 2021. A total of 14,112 patients were included in this study, with an average follow-up of 6.4years, and the incidence density was 17.9 per 1000 person-years. Insomnia symptoms were positively associated with T2DM incidence compared with those with no insomnia symptoms, regardless of competing risk model (≥ 1 symptoms: sub-distribution hazard ratio (SHR) 1.13; 95% confidence interval (CI) 1.02-1.26; P-trend = 0.012) and Cox proportional hazard model (≥ 1 symptoms: hazard ratio (HR) 1.13; 95% CI 1.02-1.26; P-trend = 0.013). The cumulative incidence function (Gray's test, p < 0.001) and Kaplan-Meier estimate (log-rank test, p < 0.001) also presented this positive relationship. This positive association was more apparent in women and participants with ages from 50 to 65 years. The PAF was 4.1% with 95% CI (0.7-7.9%). Insomnia symptoms may be an important risk factor for the development of T2DM, which is unbiased by the death competing risk. These findings suggest that management of sleep problems may be an important part of strategies to prevent T2DM.

Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis.

To quantify the gender-specific associations between insomnia symptoms and subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, which has strong predictive value for incident cardiovascular disease. We analyzed data from 1,429 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants completed standardized questionnaires and underwent polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as: self-reported trouble falling, staying or returning to sleep, early-morning awakenings, or hypnotic use, for ≥5 nights/week. MESA assessed CAC using computed tomography. We employed multivariable linear regression to model the probability of CAC >0 overall and to model the linear continuous effect among those with nonzero CAC. Our sample was a mean age of 68.1 ± 9.1 years, 53.9% female, and 36.2% white, 28.0% black, 24.2% Hispanic, and 11.5% Chinese-American. Insomnia symptoms were present in 49.7% of men and 47.2% of women. In multivariable-adjusted analyses, insomnia symptoms was associated with an 18% higher prevalence of CAC (PR 1.18, 95% CI 1.04, 1.33) among females, but no association was observed among males (PR 1.00, 95% CI 0.91, 1.08). There was no evidence that the association between insomnia symptoms and prevalence of CAC >0 differed by objective sleep duration status (by single-night PSG or multi-night actigraphy) in females or males. We found that among women, insomnia symptoms were associated with an 18% higher prevalence of CAC compared to no insomnia. Insomnia symptoms were not associated with CAC prevalence in men. Additionally, there was no evidence that the association between insomnia symptoms and CAC score >0 differed by objective short sleep duration status.

The associations of insomnia symptoms and chronotype with daytime sleepiness, mood symptoms and suicide risk in adolescents

ObjectivesTo investigate the association of insomnia and chronotype preference with daytime impairment and psychopathology in a community sample of adolescents in Hong Kong. MethodsThis was a cross-sectional study that included seven local secondary schools in Hong Kong. A total of 1667 adolescents (mean age: 14.8 ± 1.6 years old; boys: 56.5%) returned a battery of self-report questionnaires including Insomnia Severity Index (ISI) and reduced Horne and Östberg Morningness and Eveningness Questionnaire (rMEQ) for assessing insomnia symptoms and chronotype preference, respectively. A subset of adolescent samples (n = 768) were additionally assessed for suicidal ideation. Potential confounders including age, gender and sleep duration were controlled for in the analyses. ResultsThe prevalence of insomnia symptoms and eveningness chronotype was 37% and 25.6%, respectively. Regression models indicated that insomnia and eveningness were independently associated with excessive daytime sleepiness (insomnia: adjusted OR [AdjOR] = 3.8; 95% confidence interval [C.I.] = 2.9–5.0; eveningness: AdjOR = 2.6; 95% C.I. = 1.9–3.7), and an increased risk of depression (insomnia: AdjOR = 3.5, 95% C.I. = 2.5–5.0; eveningness: AdjOR = 2.0, 95% C.I. = 1.3–3.2). The odds ratio increased to 8.7 (95% C.I. = 6.1–12.3, p < 0.001) for excessive daytime sleepiness and 4.8 (95% C.I. = 3.2–7.2, p < 0.001) for depression among adolescents with both insomnia and eveningness. Insomnia symptoms, but not eveningness, were associated with anxiety symptoms (AdjOR = 5.8; 95% C.I. = 3.6–9.4) and suicidal ideation (AdjOR = 2.1, 95% C.I. = 1.4–3.2). ConclusionsThe present study provided further evidence that insomnia and eveningness uniquely contributed to poor daytime functioning and mood related outcomes, while the co-existence of these two conditions could confer a greater risk in adolescents. However, insomnia, but not eveningness, was significantly linked to suicidality after controlling for mood symptoms. Our findings highlighted the necessity of timely management of sleep and circadian issues in adolescents.

0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults

Abstract Introduction Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults. Methods Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency &amp;gt;30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits. Results Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p&amp;lt;0.001), all-cause hospitalizations (OR=1.30, p&amp;lt;0.01), preventable hospitalizations (OR=1.83, p&amp;lt;0.05), 30-day readmissions (OR=1.73, p&amp;lt;0.05), and home health care use (OR=1.27, p&amp;lt;0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p&amp;lt;0.05). Conclusion Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use. Support National Institute on Aging: R01AG050507 &amp; R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare &amp; Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

Associations of Insomnia Symptoms With Blood Pressure and Resting Heart Rate: The HUNT Study in Norway

ABSTRACTObjective: Although elevated heart rate and blood pressure might represent biologically plausible links for the association of insomnia symptoms with increased risk of cardiovascular disease (CVD), few large studies have investigated the associations of insomnia symptoms with these factors. Our aim was to investigate the associations of self-reported insomnia symptoms with systolic and diastolic blood pressure and resting heart rate in a large population-based study. Participants: Self-reported information on insomnia symptoms, including sleep initiation problems, frequent awakening and early awakenings during night, and measurements of resting heart rate and blood pressure were collected from a total of 50,806 men and women who participated in the third wave of the Nord-Trøndelag Health Study (HUNT-3) in 2006–2008. Methods: In multivariable analyses, we adjusted for sociodemographic factors, lifestyle factors, established CVD risk factors, and snoring or breathing pauses. Results: Compared to participants reporting none of the insomnia symptoms, those having all three insomnia symptoms several times a week had lower diastolic blood pressure (–0.80 [95% CI: –1.47 to –0.14] mmHg, p = 0.02), lower systolic blood (–1.69 [95% CI: –2.76 to –0.63) mmHg, p < 0.001), and higher resting heart rate (0.83 [95% CI: 0.11 to 1.55] beats/minute, p = 0.02). Conclusions: We found a modest positive association of insomnia symptoms with resting heart rate, and a modest inverse association of insomnia with blood pressure. However, the actual differences were small, and likely of less clinical importance. Prospective studies are needed to establish whether the potential link between insomnia and CVD is mediated through changes in heart rate and/or blood pressure.

Insomnia symptoms and mortality

Introduction Insomnia symptoms are associated with several health outcomes such as somatic and mental health, sickness absence and disability retirement. However, studies on the association between insomnia symptoms and mortality are few and their results inconsistent. In some studies frequent symptoms are associated with higher mortality risk, some others have found no or even reverse associations. Our aim was to examine the association of insomnia symptoms with all-cause mortality among ageing employees. Materials and methods The Helsinki Health Study baseline questionnaire survey data on 40–60-year-old City of Helsinki employees were collected in 2000–2002 (response rate 67%). These data were linked with register data on mortality until the end of 2011 ( n = 188 deaths) for those with written consent for such linkages (74%; N = 6,464). Insomnia symptoms included difficulties initiating and maintaining sleep, and non-restorative sleep (none, occasional, i.e. 1–14 nights per month, and frequent, i.e. 15 + nights per month). Baseline covariates included age, sex, education, marital status, obesity, alcohol drinking, physical inactivity, and mental health. Cox regression analysis was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI). Results At baseline, 21% of women and 17% of men reported frequent insomnia symptoms. The summary measure examining any insomnia symptoms was not associated with all-cause mortality among men or women. However, difficulties in initiating sleep were strongly associated with mortality among men (HR 4.46, 95% CI 2.03–9.77). After adjusting for all covariates, the association attenuated but remained (HR 2.78, 95% CI 1.19–6.48). No associations could be confirmed among women or for difficulties maintaining sleep and non-restorative sleep. Conclusion Difficulties initiating sleep were associated with mortality among men. Otherwise insomnia symptoms were unassociated with mortality. Studies need to examine insomnia symptoms separately, especially as they may have contrasting associations with mortality. Health care should emphasise early detection and prevention of insomnia symptoms, especially difficulties initiating sleep. Acknowledgements Funding from the Academy of Finland, Finnish Work Environment Fund and University of Helsinki.

Insomnia symptoms and subsequent cardiovascular medication: a register-linked follow-up study among middle-aged employees

Introduction Sleep disturbances have been associated with increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidemia, the main modifiable cardiovascular disease risk factors, are less studied. We aimed to examine associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidemia. Materials and methods Baseline questionnaire surveys among 40–60-year-old employees of the City of Helsinki, Finland, were conducted in 2000–2002 (N = 6,477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5–7 years prior to and 5 years after baseline. The associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidemia medication during the follow-up were analysed using logistic regression analysis (odds ratios (OR) with 95% confidence intervals (CI)). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health, and health behaviours. Results Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up 32% had hypertension medication and 15% dyslipidemia medication. Adjusting for age, gender, and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (OR 1.57, 95% CI 1.23–2.00) and dyslipidemia medication (OR 1.59, 95% CI 1.19–2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. Conclusion Insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors. Acknowledgements The authors have no conflicts of interests to report. This study has been funded with grants from Academy of Finland, Finnish Work Environment Fund, Juho Vainio Foundation, Emil Aaltonen Foundation, and Doctoral Programs in Public Health.

Insomnia symptoms and mortality

Background Insomnia symptoms are associated with several health outcomes such as somatic and mental health, sickness absence and disability retirement. However, studies on the association between insomnia symptoms and mortality are few and their results inconsistent. In some studies frequent symptoms are associated with higher mortality risk, some others have found no or even reverse associations. Our aim was to examine the association of insomnia symptoms with all-cause …

Association of insomnia symptoms with kidney disease quality of life reported by patients on maintenance dialysis

Results of many studies indicate that sleep disorders can reduce quality of life (QoL) in patients with chronic kidney disease. This study aimed to investigate therelation of insomnia symptoms to QoL among haemodialysis (HD) and peritoneal dialysis patients. A sample of 144 patients was recruited from three General Hospitals in the broader area of Athens, consisting of 84 patients undergoing in-centre HD and 60 patients in continuous ambulatory peritoneal dialysis. Measurements were conducted with the following instruments: The World Health Organization Quality of Life (WHOQOL) instrument, the General Health Questionnaire, the State–Trait Anxiety In ν entory and the Center for Epidemiologic Studies Depression Scale. The results indicated that insomnia symptoms had negative association with all the domains of WHOQOL questionnaire (physical health, psychological well-being, social relationships and environment). Insomnia symptoms were also related positively to depression as well as state and trait anxiety. The findings provide evidence that the presence of insomnia symptoms relates significantly to the negative evaluation of mental health and QoL in patients with chronic kidney disease.

Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population

This study examined the national age- and sex-specific prevalence rates of insomnia and excessive daytime sleepiness (EDS), the associations of insomnia symptoms with daytime consequences, and the impact of insomnia on EDS and psychological well-being. Data of 36,743 men and women aged 18 years and above from the 2005 Survey of Social Development Trends-Health Security in Taiwan were analyzed. Over 25% of the Taiwanese adults experienced insomnia. Difficulty initiating sleep (14.6%) was the most common type of insomnia, followed by early morning awakening (13.9%) and difficulty maintaining sleep (13.4%). The risk of EDS was three times as high for individuals with insomnia as for those without (95% confidence interval of odds ratio: 2.77-3.71). Insomnia status predicted poor psychological well-being even after controlling for sociodemographic factors and health status. Taiwanese adults had a high prevalence of insomnia. Insomnia contributed at least partially to an individual's psychological well-being.